By the age of 21, women are candidates for what is usually their first cancer screening test. “Screening” is when a test is performed to determine if there is a harmful condition or risk factor present. Going to a doctor when we feel fine, to see if we are fine, seems like a luxury of time akin to a two week vacation. During these check ups, we sometimes receive recommendations for other tests. Following through on these screening tests can be challenging because 1) we have many other responsibilities that are happening right now, 2) it is no fun having a screening exam for cancer, and 3) we feel fine.
Being born with breasts, a cervix, a uterus, and ovaries, however, is a reason to begin to take a look at the screening tests available. We can then make a personal decision with the guidance of a health care provider. We may choose not to have any of the screening tests, or we may decide to have some now and others at a later date. The self-care action of this process is to make an informed choice about this aspect of our health care rather than ignore or delay it because we have created an only negative story about the process. As we are in the zodiac of Cancer, we can look at this as a celestial reminder to make these choices versus making them by default.
Now back to turning 21. It’s not just about having a legit ID. In the US, the recommendations are to get an initial pap smear and then again every 3 years. This test, designed by Dr. Papanicolaou, was introduced widely in the US during the 1950s in order to detect if women had precancerous or cancerous cervical cells. With treatment of these conditions, the occurrence of cervical cancer decreased by 70% over the first 30 years and has continued to decrease. That is huge. Having this screening exam actually turned self care into an opportunity to keep cancer from ever developing. In addition, more recent studies have shown different strains of Human Papillomavirus (HPV) to be linked to cervical cancer. Currently there is an HPV vaccine that targets cancer causing strains of HPV that can be given to girls beginning at age 9-11. It seems young to begin immunizations for a virus that is sexually transmitted, but that is exactly how it can be most effective. The vaccine needs to be administered before a person is exposed to the virus analogous to receiving a flu shot at the beginning of flu season not when someone already has the flu.
When it comes to breasts, the experts don’t agree. There are cancer and radiological societies as well as the US Preventive Service Task Force who all evaluate the scientific studies and update the guidelines based on their interpretation of the results. Recommendations for breast cancer screening vary based on how they interpret the data. The recommendations for the age to have a first mammogram range from 40 to 50.
How do we make the decision that is right for us? We take a look at our own risk factors (conditions that place a woman at higher risk) for developing breast cancer and also at the protective factors (conditions which lower a woman’s risk) with our doctor. This will help in making a decision when to proceed (or not) with screening mammography.
Other screening exams to consider include the uterus, ovaries, lung, colon, and the largest organ of the human body, skin. Uterine and ovarian cancer do not have recommended screening exams for those without the increased risk factors such as a family history of these cancers. Lung cancer screening is recommended for those with a current or recent smoking history. Colon cancer screening begins at age 50 for those without additional risk factors, again, such as family history. For those with a family history of melanoma skin cancer, regular skin exams with a dermatology specialist is important. Those with a history of sunburns and moles need to schedule regular skin check ups with their dermatologist.
We have learned that while guidelines are in place, they are not always straightforward. What is clearly beneficial is having communication with our clinician about what tests are indicated for us and when. We can always say no to any screening exam, but isn’t it part of how we practice self care to make that conscious, informed decision?
I would also like to mention that having a cancer screening test does not mean we will be diagnosed with cancer. We intellectually know this, but it still can feel really uncomfortable and even scary to receive a test that is looking for something like cancer. Looking again at the pap smear, for example, this test can actually detect abnormal cells before they develop into a malignancy. This test and the tests mentioned above can be used as the beginning outline for preventive health care.
We all experience the urgency of work deadlines, children’s schedules, and coordination of multiple calendars, so it’s hard to imagine fitting in something that is preventive. Yet, prevention is what we are looking for to provide the added insight of detecting and/or treating a condition early rather than waiting for it to make us ill. Cancer screening exams are like eating organic foods, having play time, and going to therapy– they’re keeping us healthier, longer. Rather than conjuring fear, they can give us information about our bodies and contribute to our better future.
We’ve included a Cancer Screening Diagram to guide you.
Artwork by Michelle Favin of Whys LA for Poppy + Seed. Connect with her @whyslosangeles.